Acute ischemic stroke remains one of the main causes of death and disability in the world. The only approved therapy for stroke is the intravenous thrombolysis with recombinant tissue plasminogen activator within 3 h from symptom onset. The European, American and Canadian guidelines define unenhanced brain CT as the only imaging technique mandatory before thrombolysis. Its only goal is the exclusion of hemorrhage and not the diagnosis of ischemia, although the identification of early ischemic changes, involving more than one third of middle cerebral artery territory, was soon used in the therapeutic decision. At the moment the need of vascular imaging in the acute phase of stroke is sustained by several researchers and the practical directions actually in progress are the diagnosis of presence and site of vessel occlusion, whose prognostic role is demonstrated, and the perfusional evaluation for the quantification of core/penumbra mismatch and the overcoming of the time window concept. The ideal tool for identify reliably, easily, reproducibly and cheaply the vascular pattern in each patient is the ultrasound technique, particularly Transcranial Colour-Coded Duplex Sonography. It allows also the real-time monitoring of recanalization process, i.e. the timing of vessel patency restoration.
Keywords: Transcranial, transcranial colour-coded sonography, acute stroke, thrombolysis, vascular imaging, perfusion
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